Ali Vaez, director of the Iran project at the International Crisis Group, said although the rates of infection among senior officials reduced the government’s ability to fight the virus, the outbreak could cause even greater economic than political harm.

“Iran is already under tremendous pressure as a result of US sanctions and the economy is already reeling as a result of mismanagement and corruption,” Vaez said. “The coronavirus has basically done what the Trump administration’s sanctions failed to do: effectively completely isolated Iran.”

Despite the number of cases skyrocketing in a matter of days, Iran’s leadership has kept its focus on achieving nuclear development goals in the face of international sanctions. The International Atomic Energy Agency reported on Tuesday that the country had tripled its stockpile of uranium, and for the first time since US President Donald Trump walked away from an international agreement on the country’s nuclear programme, Iran again has sufficient fuel for a nuclear bomb.

Observers say that the pressure of US sanctions has compounded the challenge for Tehran in responding to the outbreak. Political and economic isolation have left the nation dependent on supply chains from China – which have been disrupted or shut off due to the epidemic – and experts say sanctions make financing, even for medical supplies, next to impossible.

A shortage of test kits has made it difficult to know just how many people have been infected with the virus. The government agreed to temporarily release 54,000 prisoners who it said did not have the virus to prevent them contracting it, but it is unclear if all of those prisoners were tested negative.

Health officials in Iran have complained that the government delayed in getting local health care providers the equipment and supplies they needed for testing and treatment. A technical team from the World Health Organisation (WHO) travelled to Tehran this week to help confront the outbreak.

Analysts Henry Rome and Scott Rosenstein at political risk management consultancy Eurasia Group warned in an email update that government inaction increased the risk for a broader outbreak in the country and the region.

“The government appears unable to grasp the scope or severity of the coronavirus outbreak. Supreme Leader Ali Khamenei and [President Hassan] Rowhani are probably unwilling to take decisive steps that could unsettle a population already under extreme pressure from US sanctions,” said Rome and Rosenstein.

How Iran’s coronavirus death toll came to be the highest behind only China

What risks does the outbreak pose to the country’s political leadership?

It is unclear how recently Iran’s supreme leader Ayatollah Ali Khamenei had been in contact with any of the scores of infected government officials. But at 80, the leader is at an age where the risk of contracting the virus is heightened.

Vice-President Masoumeh Ebtekar, who was a spokesperson for the students who seized the US embassy in 1979, attended a meeting with President Rowhani and his cabinet a day before she confirmed she had the virus.

“Despite the fact that the majority among the elite are in their 70s and 80s and so are particularly vulnerable to infection, the reality is that Iran has multiple power centres and the number of officials in the ruling establishment is large,” said Vaez at Crisis Group. “It is unlikely to wipe out the entire leadership.”

Mahmoud Sadeghi, an Iranian parliamentarian representing Tehran, confirmed he had tested positive for the virus and sent a message calling on the head of Iran’s judiciary to release political prisoners to prevent them from being infected.

“I send this message while I have little hope of living in this world,” Sadeghi said.

Experts warn that the government has put saving face ahead of public safety by going ahead with parliamentary elections last week and holding back on stricter containment measures like the citywide quarantines and lockdowns which have been implemented in China.

Iranian officials insisted for days that the number of cases was significantly lower than reports suggested. After the disqualification of scores of reformist candidates and amid fears of the virus spreading, last week’s parliamentary election saw the lowest turnout since the 1979 Islamic Revolution.

Coronavirus: Iran to deploy armed forces to combat outbreak

Barbara Slavin, director of the Future of Iran initiative at Washington think tank The Atlantic Council, said: “The fact that they allowed the elections to take place, did not seal off the city of Qom [where the outbreak is thought to have begun], and have not being open about the number of people infected have all been a further blow to the government’s credibility – and they didn’t have much credibility anyway.”

The outbreak comes just weeks after thousands marched in Tehran after the government denied the military had downed a Ukrainian airliner with dozens of Iranians on board. Despite the timing, Slavin said the government’s handling of the outbreak will not cause major protests.

“Who’s going to go out in the streets and protest when they could catch the virus?” said Slavin.

Coronavirus: how Disease X, the epidemic-in-waiting, erupted in China

How have US sanctions impacted Iran’s ability to contain the outbreak?

Observers say that US sanctions have hampered Iran’s ability to contain the outbreak – by keeping it reliant on sustained economic interaction with China despite the threat of the epidemic spreading, and by constraining the country’s ability to import badly needed medical supplies.

Multiple analysts told South China Morning Post that officials in Iran held back from implementing stricter quarantine measures like locking down cities as China as done because they fear it could deepen the economic strain the country is already under as a result of the sanctions.

“Like everything else in Iran, the impact of sanctions makes a bad situation worse,” Vaez said.

“The fact that US sanctions deprived Iran of the medical equipment they needed to conduct tests and look after patients without any doubts exacerbated the crisis.”

US sanctions technically exclude items for humanitarian purposes such as food and medicine, but the Trump administration has further restricted trade under counterterrorism laws. After designating part of Iran’s military as a terrorist organisation in 2019, the Trump administration listed multiple Iranian banks as terrorist entities, making it more challenging for them to pay for humanitarian goods.

Esfandyar Batmanghelidj, Iran scholar and founder of Bourse & Bazaar, said the administration should expand the definition of humanitarian goods to include items needed to combat the virus.

“You can imagine that for something like medication it’s fairly straightforward what the end use is, but let’s think about hazmat suits. These are not goods that are as easily definable as humanitarian,” Batmanghelidj told American international affairs magazine The National Interest.

France, Germany and the UK on Monday announced they were urgently transporting equipment for medical tests as well as protective body suits and gloves to the country and pledged US$6.4 million to fight the epidemic through the WHO and other United Nations agencies.

What risk does the outbreak in Iran pose for the rest of the region?

Iran’s outbreak has already been the source of infections elsewhere. Though experts say neighbouring nations are at the highest risk, cases as far away as New York City have already been connected with the outbreak there.

The first confirmed cases in Saudi Arabia, Iraq, Lebanon, Georgia, Qatar, New Zealand and New York were all linked to people who had recently travelled to Iran. Kuwait’s health ministry reported cases earlier this week, all linked to Iran.

The United Arab Emirates sent a shipment of medical supplies, including gloves and surgical masks, to Iran on Monday, state media reported.

Last week, a team of six Canadian epidemiologists said that based on infection rates elsewhere, flight data and travel patterns, Iran could have at least 18,000 cases of the virus.

Coronavirus: what you need to know and how to protect yourself

Asif Shuja, senior researcher at the Middle East Institute at the National University of Singapore, said that sanctions had caused Iran to deepen its relations with a small number of countries in the region.

“There are chances of high concentration of people travelling between the same countries – Iraq, UAE, Oman, Qatar, Syria, Lebanon and Yemen – and Iran,” Shuja said. “It may not be an exaggeration to say that Iran has already become the epicentre of an outbreak within the Middle East.”

Neighbours Turkey, Pakistan, Afghanistan and Armenia over the weekend announced temporary closures to shared land borders. Kuwait said it would bar Iranian ships from docking, and Jordan, Iraq and Saudi Arabia have implemented travel restrictions.

Analysts warn that these border closures could lead to a serious crisis for Iran’s economy, which depends on oil and gas exports to its neighbours.

However, the crisis won’t topple the regime, said Rome and Rosenstein at Eurasia Group.

“As in the January shootdown of a passenger plane, the erosion of public trust in government poses a serious, long-term threat to the legitimacy of the Islamic republic, but for the time being the government retains the repressive capability to contain most challenges,” they said.